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Executive Summary: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE (PEACE) Consensus

Peta M A Alexander1, Melania M Bembea2, Katherine Cashen3

  • 1Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|July 3, 2024
PubMed

Insights

This study provides 91 consensus statements for managing anticoagulation in pediatric extracorporeal membrane oxygenation (ECMO) patients. These evidence-based guidelines aim to standardize care and inform future clinical trials for critically ill children on ECMO.

Area of Science:

  • Pediatric Critical Care Medicine
  • Cardiovascular Surgery
  • Hematology

Background:

  • Extracorporeal membrane oxygenation (ECMO) is a life-support technology for critically ill children with cardiorespiratory failure.
  • Optimizing anticoagulation management is crucial for ECMO efficacy and patient safety, yet clinical practices vary.
  • The Pediatric ECMO Anticoagulation CollaborativE (PEACE) initiative aimed to establish standardized guidelines.

Purpose of the Study:

  • To develop evidence-based recommendations and consensus statements for the clinical management of anticoagulation in pediatric ECMO patients.
  • To provide a comprehensive framework for anticoagulation care, addressing general management, perioperative considerations, and bleeding/thrombosis events.
  • To identify knowledge gaps and research priorities in pediatric ECMO anticoagulation.

Main Methods:

  • A systematic literature review was conducted across major databases (PubMed, Embase, Cochrane Library) from 1988 to 2021.
  • International, interprofessional experts convened through serial meetings to develop statements.
  • Consensus was achieved using the Research and Development/UCLA Appropriateness Method, with results graded by the GRADE system.

Main Results:

  • A total of 91 statements were developed: 23 recommendations, 52 expert consensus statements, and 16 good practice statements.
  • These statements cover general care, monitoring, perioperative management, and non-procedural bleeding or thrombosis.
  • Three research-focused good practice statements were also identified, highlighting areas for future investigation.

Conclusions:

  • The 91 consensus statements provide a foundation for standardizing anticoagulation management in pediatric ECMO.
  • These guidelines are intended to improve clinical care and serve as a basis for future clinical trials.
  • The PEACE initiative addresses critical aspects of anticoagulation, aiming to enhance outcomes for children on ECMO.
Abstract

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